A bunionette, commonly known as a tailor’s bunion, is a bony enlargement that develops on the side of the foot near the pinky toe. This condition occurs at the fifth metatarsophalangeal (MTP) joint, where the smallest toe connects to the rest of the foot. The enlargement often causes pain, redness, and inflammation due to friction against footwear. When conservative treatments fail, medical and surgical interventions are available to address the discomfort and deformity.
Understanding the Bunionette
A bunionette forms when the head of the fifth metatarsal bone protrudes outward, creating a noticeable bump on the outside of the foot. This deformity is often caused by a combination of inherent foot structure and external forces. Hereditary factors, such as an abnormal or bowed fifth metatarsal bone, can predispose an individual to developing a bunionette.
External pressures also play a significant role in the development and progression of the condition. Wearing shoes with a narrow toe box, pointed tips, or high heels forces the toes together and pushes the fifth metatarsal head outward. This consistent pressure over time can alter the foot’s bony framework, leading to the characteristic enlargement and irritation.
Non-Surgical Relief and Conservative Management
The initial approach to managing a bunionette focuses on relieving symptoms and accommodating the deformity without surgery. The most immediate and effective change is a modification of footwear. Choosing shoes that feature a wide, deep toe box is essential to reduce pressure and friction on the bony prominence.
Over-the-counter accessories provide cushioning and protection from shoe irritation. Bunionette pads, often made of fleece or silicone gel, act as a barrier to minimize rubbing against footwear. Taping the fifth toe can also offer mild support and help maintain a more natural toe alignment.
Inflammation and pain can often be managed with readily available treatments. Applying ice or cold packs to the affected area helps to minimize swelling and reduce local discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken orally to reduce both pain and inflammation associated with the joint irritation.
Simple exercises can also be performed at home to maintain flexibility and strengthen the foot muscles. Stretching the calf muscles and engaging in toe curls or marble pickups helps improve foot mechanics and support the arch.
Advanced Professional Interventions
When conservative treatments do not sufficiently alleviate pain, a podiatrist can offer more advanced non-surgical interventions. Prescription custom orthotics are molded to the individual’s foot to provide precise support and redistribute pressure away from the fifth metatarsal head. These specialized shoe inserts help control foot movement and improve overall alignment.
Corticosteroid injections may be administered directly into the inflamed joint or bursa sac near the bunionette. This localized treatment delivers a potent anti-inflammatory medication to quickly reduce swelling and pain, offering temporary but substantial relief. These injections are generally reserved for cases where inflammation is a primary source of discomfort.
Physical therapy often plays a supportive role, especially when biomechanical issues contribute to the problem. A physical therapist can conduct a gait analysis to identify abnormal walking patterns that place excessive stress on the outside of the foot. They can then prescribe specialized exercises and manual therapy techniques to improve joint mobility, strengthen intrinsic foot muscles, and correct poor mechanics.
Surgical Correction Options
Surgery is typically considered only after a patient has exhausted all non-surgical options and continues to experience significant pain. The goal of surgical correction is to permanently eliminate the bony prominence and realign the foot’s structure. The specific procedure chosen depends on the severity and type of the bunionette deformity as determined by X-ray imaging.
One procedure, called an exostectomy, involves shaving off the bony bump from the side of the metatarsal head. This procedure is generally reserved for very mild cases where the bone itself is simply enlarged, not significantly misaligned. However, exostectomy alone does not correct the underlying joint misalignment, and it is often performed in conjunction with other corrective measures.
More advanced deformities require an osteotomy, which involves cutting and repositioning the fifth metatarsal bone to restore proper alignment. The surgeon makes precise cuts, shifts the bone’s head inward to narrow the forefoot, and secures the new position with small pins or screws. Following surgery, patients typically wear a surgical boot and begin weight-bearing activity within a few weeks, with a full recovery often taking six to eight weeks.